Tài liệu ACT Auditor-General’s Office Performance Audit Report: Emergency Department Performance

ACT Auditor-General’s Office

Performance Audit Report

Emergency Department Performance

Information

Report No. 6 / 2012

Health Directorate

July 2012

PA 12/06

The Speaker

ACT Legislative Assembly

Civic Square, London Circuit

CANBERRA ACT 2601

Dear Mr Speaker

I am pleased to forward to you a Performance Audit Report titled ‘Emergency

Department Performance Information’ for tabling in the Legislative Assembly pursuant

to section 17(5) of the Auditor-General Act 1996.

Yours sincerely

Dr Maxine Cooper

Auditor-General

3 July 2012

CONTENTS

List of abbreviations ................................................................................................................................... 1

1. Report summary and conclusions .................................................................................................... 3

Introduction ............................................................................................................................................3

Audit objectives.......................................................................................................................................4

Audit conclusion......................................................................................................................................4

Key findings.............................................................................................................................................7

Recommendations and response to the report....................................................................................11

2. Emergency Department performance information ........................................................................ 23

Introduction ..........................................................................................................................................23

Summary ...............................................................................................................................................23

Emergency Department waiting times .................................................................................................25

The National Emergency Access Target ................................................................................................29

Reporting of Emergency Department performance information .........................................................33

Emergency Department clinician views on performance indicators ....................................................34

Other jurisdictions’ experience of performance information reporting ...............................................37

3. Systems and processes for reporting performance information..................................................... 43

Introduction ..........................................................................................................................................43

Summary ...............................................................................................................................................43

Emergency Department management information systems................................................................45

EDIS governance arrangements............................................................................................................46

ACT Government legislation and policy ................................................................................................51

System security and access controls.....................................................................................................54

EDIS practice in ACT emergency departments......................................................................................65

Data validation activities.......................................................................................................................68

Monitoring, review and assurance of performance information by the Health Directorate................70

4. Data manipulation at the Canberra Hospital.................................................................................. 73

Introduction ..........................................................................................................................................73

Summary ...............................................................................................................................................73

Data integrity concerns.........................................................................................................................74

Data manipulation.................................................................................................................................80

Implications for person manipulating hospital records ........................................................................83

Motivation for data manipulation.........................................................................................................85

Breach of employment conditions........................................................................................................91

Appendix A: Audit criteria, approach and method ............................................................................. 92

Audit objective ......................................................................................................................................92

Scope.....................................................................................................................................................92

Out of scope ..........................................................................................................................................93

Audit approach and method .................................................................................................................93

Emergency Department Performance Information Page 1

LIST OF ABBREVIATIONS

ACT Australian Capital Territory

ACTPS ACT Public Service

AIHW Australian Institute of Health and Welfare

ATS Australasian Triage Scale

ACEM Australasian College for Emergency Medicine

COAG Council of Australian Governments

EDIS Emergency Department Information Solution

ICT Information communication & technology

KPI Key Performance Indicator

NEAT National Emergency Access Target

NSW New South Wales

PWC PricewaterhouseCoopers

UK United Kingdom

VAGO Victorian Auditor-General’s Office

Emergency Department Performance Information Page 3

1. REPORT SUMMARY AND CONCLUSIONS

INTRODUCTION

1.1 This report presents the results of a performance audit that examined the

circumstances associated with the alleged manipulation and misreporting of

Emergency Department performance information at the Canberra Hospital.

Emergency Department services in the ACT

1.2 In the ACT, emergency hospital services are provided at the Canberra Hospital

(Woden) and Calvary Public Hospital (Bruce). The Canberra Hospital is operated

by the ACT Health Directorate. The Calvary Public Hospital is operated by Calvary

Health Care ACT Ltd on behalf of the Health Directorate.

1.3 In June 2011 an Expert Panel, which was commissioned to provide advice on the

implementation of the National Partnership Agreement on Improving Public

Hospital Services targets and incentives, reported:

Emergency departments are the face of the public hospital system, and problems

in emergency departments, such as overcrowding and ambulance queues are the

most visible sign of strain on our public hospitals to patients and the general

public.

In 2009–10, Australian public hospitals provided almost 7.4 million accident and

emergency services, with an annual growth rate of 4.3 per cent per year over the

past five years. In conjunction with the increase in demand for emergency

services, there has been an increasing awareness of the extent and impact of

emergency department overcrowding, including delays in patient care.

As emergency departments fill up to their capacity and beyond, staff are stretched

between more patients, it takes longer for patients to be seen, and ambulances

begin queuing or are diverted as there is no room for new patients.1

1.4 In 2010-11 the Health Directorate reported that there were 112,213

presentations to ACT emergency departments. This was an increase of 5 percent

over 2009-10 figures and represents an overall increase of 15 percent since

2007-08.

1.5 Timely access to treatment in the ACT’s emergency departments is important to

the ACT community and the timeliness performance of the ACT’s emergency

departments is a continuing focus of the ACT Legislative Assembly, the media

and the broader community.

1 Expert Panel Review of Elective Surgery and Emergency Access Targets under the National Partnership Agreement on

Improving Public Hospital Services. Report to the Council of Australian Governments. 30 June 2011, p.21.

Report summary and conclusions

Page 4 Emergency Department Performance Information

Canberra Hospital Emergency Department data anomalies

1.6 On 5 April 2012 the Australian Institute of Health and Welfare (AIHW) notified

the Health Directorate of some apparent anomalies in Canberra Hospital

Emergency Department data that had been provided to AIHW. In response,

between 9 April 2012 and 19 April 2012 the Health Directorate undertook some

initial investigations into the potential data anomalies. The Health Directorate’s

initial investigations indicated that a more detailed investigation was required.

1.7 Following the initial investigations, on 21 April 2012 an executive met with the

Director-General of the Health Directorate and admitted to making improper

changes to hospital records.

1.8 On 24 April 2012 the Director-General of the Health Directorate held a media

conference in relation to the matter. On 27 April 2012 the ACT Health Minister

wrote to the Auditor-General requesting the Auditor-General ‘undertake a

performance audit of the Health Directorate’s data collection, reporting and

integrity systems.’ On 1 May 2012 the ACT Legislative Assembly passed a

resolution which, inter alia, requested ‘the Auditor-General to inquire into data

discrepancies in Emergency Department waiting times at The Canberra Hospital.’

1.9 On 3 May 2012, the Auditor-General issued a media release announcing that the

ACT Auditor-General’s Office would conduct a performance audit in relation to

the matter.

AUDIT OBJECTIVES

1.10 The objective of this audit was to provide an independent opinion to the

Legislative Assembly on:

 the circumstances associated with the alleged misreporting of Canberra

Hospital Emergency Department performance information;

 the effectiveness of the Health Directorate’s systems and processes for

reporting Emergency Department performance information; and

 the financial implications for the Territory associated with any potentially

misreported Emergency Department performance information.

AUDIT CONCLUSION

1.11 The audit conclusion drawn against the audit objectives are set out below.

Hospital records at the Canberra Hospital have been deliberately manipulated to improve

overall performance information and reporting of the Canberra Hospital’s Emergency

Department. The very poor controls over the relevant information system means that it

is not possible to use information in the system to identify with certainty the person or

persons who have made the changes to the hospital records. Under affirmation, an

executive at the Canberra Hospital has admitted to making improper changes to hospital

records. While this is the case, Audit considers that it is probable that improper changes